Setting the stage

Surgery is a specialised world, and the training for it reflects this. Last June, Professor Arthur Tanner, a consultant at Tallaght Hospital, was appointed as the first director of surgical affairs at the RCSI. The brief is to maintain and improve existing professional activities, and also to develop new learning opportunities.

The qualifications in medicine are only an entrance ticket to surgical training, he explains. After this qualification there are two periods of training. The first lasts for about three years and is generic to all surgery. This ends with examinations, written and practical, for the associate fellowship.

But after this there follows another six year period of higher surgical training before anyone becomes qualified to be a consultant - and usually there are further studies and research in whatever specialised area of surgery a person has chosen.

This means that a consultant is normally close to 40 years of age before qualifying; it's an age where, in other walks of life, people are looking at changes of direction or even beginning to think of early retirement.

Surgery is a craft: no less than cabinetmaking or master musicianship, it requires dedication and practice. Like other crafts, it has been taught through what is basically an apprenticeship system. On the plus side, this allows teachers to assess aspects which are not easily judged in examinations.

On the minus side, if surgery is taught in the operating theatre, it obviously means that some time and attention has to be spent on the teaching element, which results in fewer operations being performed.

The higher surgical training is inter-collegiate, run by the four royal colleges in London, Glasgow, Edinburgh and Dublin, and Prof Tanner is chairman of the Basic Surgical Training and Examinations Committee.

Life is changing, and so is medicine. In former times, the consultant was like a god as he swept through the hospital attended by a retinue - an image seen in film comedies. He (it was very seldom she) once appointed, had a year's probationary period, but after that had a life-long tenure in a job of high responsibility, often with little support and much loneliness.

Unlike, say, the US, where there is a free market and anyone who qualifies can set up as a surgeon, here in Ireland the number of surgical places is regulated by Comhairle na nOspuideal. This has meant that, where appointments have not been ratified, some graduates have gone abroad to do post-senior registrar research, and Ireland has lost surgical talent having provided all the facilities to train it.

The essential strategy is mapping out a career path for the profession which takes account of the demanding nature of the job, in physical, mental and emotional aspects. And it is demanding: for instance, a liver transplant, one of the newer procedures which has become reasonably frequent, will last seven hours, if everything goes well.

Even on routine days, the hours are long: typically a surgeon will work a 12hour day, five days a week. Obviously, if there is an emergency, this can increase dramatically. What it means is that holidays can be planned, but there is a heavy toll on social life, and especially family life.

When the junior doctors won a cut in hours, which he fully supports, it had a knock-on effect for educators: how would the shorter experience affect training?

With questions such as this in mind, the emphasis is now firmly on teamwork. This will allow for everyone to contribute according to talent and experience.

Teamwork is close to his own way of thinking. In rugby, he played at scrumhalf, and nowadays he is medical officer to the Leinster rugby squad and the Ireland A team. This involved three tours, each lasting from a Wednesday to a Sunday, and it would be impossible if he hadn't generous team colleagues ready to cover for him.

In 18 months Arthur Tanner will retire from hands-on surgery to work full-time for the RCSI. He readily admits he will miss the operating theatre, but his own contribution will still be felt throughout the profession.